Archive for the ‘Assisted Reproduction’ Category

﻿﻿﻿Countries – indeed, whole regions of the world – which disallow or severely curtail IVF and/or gamete donation are often mistakenly called “highly regulated” environments. Heavy restrictions, usually with religious underpinnings or simply borne out of a failure to think progressively, hardly constitute regulation. They are more accurately described as prohibitions.

Compared with places like Italy, the Middle East, England and Canada (specifically with regard to paid gamete donation in these last two countries), the fertility industry in the United States has been likened to the “Wild West” – a loosely regulated landscape where anything is possible. This is just not true. The FDA, the mandates of various states vis a vis gamete donation (New York is prominent here), the ASRM (even though it oversteps its bounds with attempts at economic regulation) and the internal administrative policies of many responsible IVF clinics prove that significant regulation exists to shape appropriate conduct and safeguard the health of all IVF patients and egg/sperm donors. I think that we need better and more refined regulation so that we cut the lag time between scientific advancement and policies designed to effectively govern practice. But little regulation in the US? Not the case.

The appellate division held that a married woman had to adopt her husband’s child.

The child was created with her husband’s sperm and a donor egg. The resultant embryo was then transferred into a gestational carrier who gave birth to the child. The married woman argued that if she was artificially inseminated with donor semen, her husband would be considered the legal father pursuant to New Jersey statute. While the statute does provide for legal recognition of the husband, the Court distinguished this case and required an adoption.

The Connecticut Supreme Court, on January 7, 2011, held that a gay man, not biologically related to his twins, could have his name placed on their birth certificates establishing legal parentage over them along with the twin’s biological father. This decision, if structured properly through an attorney, means that a gay family utilizing gestational surrogacy in Connecticut will no longer need to have the non-biological parent adopt the child in a second-parent adoption.

With the advent of IVF, what to do with excess (or leftover) embryos became a surprising problem for infertile couples. Previously, they had no family; now, they have a family of embryos! Embryos that may be donated, without the need for adoption.

After creating a family with a few of the embryos, many of those couples (or single parents) choose to donate the excess embryos to other individuals for conception. This is a real alternative to destruction and donation to scientific research.

The legalities of donating embryos to another infertile person(s) is relatively simple: it involves a contract between the donating and recipient parties. The parties’ identities may be guarded by the respective attorneys. It is viewed as any other donation of genetic material. However, some intermediaries call this process “embryo adoption.” That is a misnomer – no adoption is necessary. As the ASRM stated this month, the correct term is, in fact, “embryo donation”. “Home visits, judicial review and other adoption procedures are not necessary and not appropriate for a patient whose case entails what is most accurately characterized medically as a tissue donation,” stated in December issue of the journal Fertility & Sterility.

Parties with excess embryos should not be dissuaded from giving their unwanted embryos to another infertile person and couples should not be discouraged from receiving them because of inaccurate beliefs that they would have to undergo an adoption.

The National Institutes of Health moved closer this week to fulfilling President Obama’s promise earlier this year that he would lift restrictions on funding human embryonic stem cell research. Human embryonic stem cell research can help us determine how diseases arise, test new drugs, and create new cells to repair ailing tissue.

These latest developments give realistic options to patients who have leftover embryos stored at clinics around the country. When patients go through IVF to create embryos, whether with their own genetic material or that of a donor, they often have leftover embryos. With the increasingly successful IVF rates, doctors implant fewer embryos with better results. That means there are more leftover embryos of which to dispose.

Patients may choose to keep the embryos in storage, but that can cost hundreds of dollars a year in fees, and isn’t a final answer. They may choose to donate them to another person, but are often hesitant as the embryos would be the genetic siblings to their own children. Finally, they may choose to destroy them. However, after years of infertility, and the emotional and financial struggles that go along with that, patients have a philosophically hard time in doing so. A more popular option, therefore, may be to donate them to medical research with the idea that they are then helping society as a whole, even if the embryos are ultimately destroyed.

However the patients feel, they should speak with a fertility counselor, their doctor and an attorney in making their decision.

On the birth certificate application filled out at the hospital, the birth mother chooses whatever name she wishes for the baby (or it is labeled “Baby Girl/Boy” with her last name). Then, in order to have the birth certificate released to my office, she executes my office’s birth certificate request form and must use the same name as on the birth certificate application (which I often don’t have a chance to see, as it is filled out during her stay prior to discharge). These names must also mirror the name listed on the consent/surrender documents (or at least the consents must include an a/k/a notation). I have had an increasingly difficult time trying to keep these matched up.

Some counties will just not release a birth certificate if there is a slight inconsistency in spelling, even though they know full well about whom the request pertains.

Claims have been made that Michael Jackson was not the genetic father of his children Prince Michael I and Paris, and that Debbie Rowe, his ex-wife who gave birth to them, was not the genetic mother [click for more] . That is, Debbie Rowe was a gestational carrier, implanted with embryos created with donor sperm and donor egg. Whether the donor material came from known or anonymous donors is a mystery, along with the rest of these questions.

All seem to agree the children were created in vitro, opening the possibility that donor material was probably used , at least in part. Just think of all the possible scenarios:

Michael Jackson sperm; Debbie Rowe’s egg

anonymous donor sperm; Debbie Rowe’s egg

anonymous donor sperm; anonymous donor egg

Michael Jackson sperm; anonymous donor egg

known sperm donor; Debbie Rowe’s egg

known sperm donor; known egg donor

etc!

Debbie Rowe insists that she is the genetic mother and wants custody; DNA tests will prove this one way or the other eventually. But she already forfeited custody to Jackson: does she have any legitimate claim (if she is the genetic mother or not)? And what if the children are not related to Michael Jackson genetically? Does this strengthen Debbie’s Rowe’s claim for custody? And what if the sperm donor was known (his identity was known to Michael Jackson)? Does the donor have any claims?

Here’s what we do know: the State of California is arguably the most progressive in the US regarding surrogacy; more surrogacies take place in California than in any other state. California case law shows that courts consider the intent surrounding the conception as the primary factor in determining custody. So if Debbie Rowe basically agreed to bear Michael Jackson’s kids for him, with the intent of his achieving full custody eventually, a court may very well rule in favor of Jackson’s estate, no matter the source of the genetic material.

However, it is unknown whether any parentage proceedings during the course of the pregnancies (if eggs to form embryos did not come from Rowe) culminated in Orders allowing the original birth certificates for the children to list only Michael Jackson as parent. As Rowe and Jackson were married at the time of the births, absent such proceedings, Rowe’s name would be listed as mother on the birth certificates and she could not have voluntarily terminated her parental rights without an adoption and another parent stepping-in to assume them.

There may have been a surrogacy contract as well as sperm and egg donor contracts; we would assume that these would have been drafted by Jackson’s lawyers and that Rowe and any donor(s) would have had independent review by competent counsel. But we cannot know for sure at this point.

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